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Evidence summaries

Transfusion Thresholds for Guiding Allogeneic Red Blood Cell Transfusion

Transfusions with allogeneic red blood cells in anaemic patients with haemoglobin thresholds above 7 g/dL to 8 g/dL is effective in decreasing the proportion of participants exposed to red blood cell transfusion by 43% across a broad range of clinical specialities compared with a transfusion threshold of 9 g/dL to 10 g/dL, without affecting 30-day mortality or morbidity (i.e. cardiac events, stroke, pneumonia, and thromboembolism). Level of evidence: "A"

Comment: There were insufficient data of the safety of transfusion in certain clinical subgroups, including acute myocardial infarction, neurological injury/traumatic brain injury, stroke, thrombocytopenia, cancer, haematological malignancies, and bone marrow failure

Summary

A Cochrane review [Abstract] 1 included 31 studies with a total of 12 587 subjects assessing the optimal haemoglobin threshold for the use of red blood cell (RBC) transfusions in anaemic patients (across a range of clinical specialities e.g. surgery, critical care). The restrictive transfusion threshold used a lower haemoglobin level to trigger transfusion (most commonly 7 g/dL or 8 g/dL), and the liberal transfusion threshold uses a higher haemoglobin level to trigger transfusion (most commonly 9 g/dL to 10 g/dL). Restrictive strategies reduced the risk of receiving a RBC transfusion by 43% across a broad range of clinical specialties (table T1). Overall, restrictive transfusion strategies compared with liberal transfusion strategies did not increase or decrease the risk of 30-day mortality or any of the other outcomes assessed (i.e. cardiac events, myocardial infarction, stroke, thromboembolism, pneumonia, wound, or bacteraemia) (table T1).

Restrictive compared with liberal transfusion protocols for guiding allogeneic red blood cell transfusion in anaemic adults and children

OutcomeRelative effect(95% CI)Assumed risk -Control - Liberal transfusion (Hb 9 g/dL to 10 g/dL)Corresponding risk - Intervention - Restrictive transfusion (Hb 7 g/dL to 8 g/dL)No of participants(studies) Quality of evidence
People receiving blood transfusionsRR 0.57 (0.49 to 0.65)841 / 1000479 / 100012 587 (31), High
30-day mortalityRR 0.97 (0.81 to 1.16)93 / 100090 / 100010 537 (23), Moderate
Myocardial infarctionRR 1.08 (0.74 to 1.60)17 / 100019 / 10008 303 (16), High
Congestive heart failureRR 0.78 (0.45 to 1.35)36 / 100028 / 10006 257 (12), Low
Cerebrovascular accident - strokeRR 0.78 (0.53 to 1.14)17 / 100013 / 10007 343 (13), High
RebleedingRR 0.75 (0.51 to 1.10)163 / 1000144 / 10003 108 (6), Low
PneumoniaRR 0.94 (0.80 to 1.11)82 / 100076 / 10006 277 (14), High
ThromboembolismRR 0.77 (0.41 to 1.45)10 / 10008 / 10004 019 (10), High

Clinical comments

Note

Date of latest search: 27 May 2016

    References

    • Carson JL, Stanworth SJ, Roubinian N et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2016;(10):CD002042. [PubMed]

Primary/Secondary Keywords